Bioethics in end-of-life decisions in neonatology: Unresolved issues

Arnáez, Juan; Tejedor, Juan Carlos; Caserío, Sonia; Montes, María Teresa Escobar Gil de; Moral, Mónica; Dios, Javier González de; García‐Alix, Alfredo

doi:10.1016/j.anpede.2017.03.011

Cited by 5 publications

(12 citation statements)

References 30 publications

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“…The attention of the NB to the limit of viability requires a look focused on PC, to avoid suffering and dignify life and death. [ 22 23 ] The role of the nurse is: to support families for decision making that helps clear information; take care not only of physiological aspects but also participate in the defense of the patient and allow time, closeness and intimacy between the parents and the newborn;[ 23 ] as well as the other environmental aspects that favor tranquility and respond to the individual needs of each family.…”

Section: Discussionmentioning

confidence: 99%

Peaceful end of life in an unviable newborn: A case report

Agudelo

Romero

Gualdrón

2020

Indian J Palliat Care

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The limit of viability is a period of uncertainty regarding the prognosis and treatment, where palliative care (PC) is important to dignify death, although, in several countries, they are not implemented as in Colombia. The peculiarities of newborns make PC differ from care at other stages of life and which are rarely accepted by professionals who consider them overwhelming. The case of a newborn of 23 weeks of gestation is exposed where nursing care is revealed to the newborn and his family according to the theory of the peaceful end of life (PEL). The theory of the PEL is useful in the development of neonatal PC, which must be differentiated, improving well-being, and family support. Furthermore, health systems must recognize emotional risks for professionals.

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Section: Discussionmentioning

confidence: 99%

Peaceful end of life in an unviable newborn: A case report

Agudelo

Romero

Gualdrón

2020

Indian J Palliat Care

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“…18,22 Furthermore, there are challenges and conflicts regarding cDCD and of how it should be included in neonatal care. 6,[15][16][17][18]23 First, despite recommendations of criteria and time to establish neonatal cDCD, substantial variability remains. In most centers, pediatric cDCD will only occur if the time to death after WLST does not exceed 1-2 h because of warm ischemic effects on organs and procurement logistics.…”

Section: Ta B L E 2 Characteristics Of the Infants Who Died After Eol Decisions At 38 Participating Hospitals During The Study Periodmentioning

confidence: 99%

“…A number of authors expressed concerns about questions such as where WLST would be carried out, the arrangements that to be made for the family to accompany the infant, who would verify cDCD and death, which drugs and procedures could be utilized prior to WLST, and the procedure to be followed if the patient dies at home or does not die. 16,17 To minimize doubts and fears, training in EoL and donation processes should be provided to healthcare professionals in all specialisations and disciplines who may be involved in the care of potential or actual donors, and not just critical care professionals. 30 Our study has some limitations, most of them due to its retrospective nature.…”

Section: Ta B L E 2 Characteristics Of the Infants Who Died After Eol Decisions At 38 Participating Hospitals During The Study Periodmentioning

confidence: 99%

“…8,14,15 However, although neonatal donation brings benefits to the family nucleus in terms of fullfilling usefulness and integration in bereavement, doubts also arise about ethical aspects related to the donation process. 6,[15][16][17][18] We hypothesized that a non-neglible number of neonates who die in Spanish NICUs could serve as organ and/or tissue donors after cDCD. We carried out a survey using a questionnaire sent to all 90 level III neonatal units in the country, in order to explore: 1) protocols, education, and specific opinions on donation held by clinicians working in NICUs and 2) potential neonatal cDCD donors that could have been eligible in Spain over a 2-year period.…”

Section: Introductionmentioning

confidence: 99%

“…Worldwide studies aimed at responding to the neonatal patient's contribution to pediatric DCD remain scarce, 4,6,9–13 as do specific recommendations for this population 8,14,15 . However, although neonatal donation brings benefits to the family nucleus in terms of fullfilling usefulness and integration in bereavement, doubts also arise about ethical aspects related to the donation process 6,15–18 …”

Section: Introductionmentioning

confidence: 99%

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Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs

Caserío

Arnáez²

2021

Pediatric Transplantation

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Background: Organ donation continues to increase worldwide, but in general paediatric patients remain less likely to receive a transplant. The inclusion of neonates as donors after cDCD should be considered in an effort to increase donation rates. Methods:The survey for a cross-sectional national study of potential cDCD neonatal donors (Maastricht type III) was sent to all 90 level III Spanish neonatal units to explore: 1) protocols, education, and specific opinions on donation and 2) potential cDCD that could have been eligible over a 2-year period (2014)(2015).Results: Forty-five centers (50%) completed the survey, and 38/45 gave information about potential eligible donors. In 16% of the centers specific protocols on neonatal donation exist. All hospitals demanded more specific training, and 65% noted that the donation process could be a problem in the family's dismissal of the child.During the study period 46 805 neonates were admitted in the 38 centers, and 625 neonates died. Ninety-five born at a gestational age ≥34 weeks and above 2000 gr died after an EoL decision, 38 (40%) and 13 (14%) of them due to neonatal encephalopathy and multiple congenital anomalies, respectively. There were 31 (33%) elegible infants who died in less than 120 min due to pathologies that did not contraindicate donation.Conclusions: Neonatal cDCD could help to reduce the gap between the supply of and demand for organs according to the potentially eligible patients emerging from this study. Training in EoL and donation processes should be provided to healthcare professionals.

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Perinatal hypoxic-ischaemic encephalopathy: a national survey of end-of-life decisions and palliative care

Arnáez

Herranz-Rubia

García‐Alix

2019

BMJ Support Palliat Care

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ObjectiveTo explore end-of-life (EoL) decision-making and palliative care in hypoxic-ischaemic encephalopathy (HIE) nationwide.MethodsA cross-sectional national study on moderate-to-severe HIE in newborns ≥35 weeks’ gestational age in 2015, including all 57 level III units that offered hypothermia. Forty-one questions were included to explore how the prognosis is established, as well as timing of the decision-making process, and also how ongoing palliative care is offered.ResultsThe main difficulties in EoL decisions lie in the scarce time to make an early, accurate prognosis. Only 20% shared the neurological prognosis with the parents within 72 hours of life, and in only a third of the centres is the nurse present when the prognostic information is given to the family. Almost 50% do not use protocols to order the EoL process. Practically, all centres (91%) reported taking into account the wishes of the parents. However, in 30% the team does not always reach consensus on how the withdrawal process. Specialised psychological support is available in 54% of the hospitals; in more than 50%, interviews are not arranged to examine the grieving process with parents.ConclusionsThere are four areas for improvement in the comprehensive, multidisciplinary approach to the EoL decision in the patient with HIE: (1) the need for EoL and interdisciplinary palliative care protocols, (2) participation of nurses in the process and improvement in the nurse–physician communication, (3) psychological support for parents involved in the EoL decisions and (4) implementation of strategies to give support during the grieving process.

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Bioethics in end-of-life decisions in neonatology: Unresolved issues

Cited by 5 publications

References 30 publications

Peaceful end of life in an unviable newborn: A case report

Peaceful end of life in an unviable newborn: A case report

Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs

Perinatal hypoxic-ischaemic encephalopathy: a national survey of end-of-life decisions and palliative care

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